Splenic cysts are very rare lesions, most of them being parasitic systs. Nonparasitic cysts are uncommon. We report a case of young female who presented with mass and pain abdomen. Ultrasound examination revealed splenic syst. The diagnosis of epidermoid cyst was made based on characteristic lining on histopathological examinatio

Usha, R

Vijay Shankar, S

English

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Epidermoid Cyst of Spleen

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Case Report:
Epidermoid Cyst of Spleen
Vijay Shankar S, Assistant professor, Department of Pathology,
Usha Ramachandra, Professor and HOD, Department of Pathology,
Adichunchangiri Institute of Medical Sciences, BG Nagara. Nagamangala taluk, Mandya district, Karnataka
Address For Correspondence:
Dr. Vijay Shankar S,
No 45, Ananda shylam, 3rd cross, 1st main
KN extension, Yeswanthpur,
Bangalore - 560022, Karnataka, India.
E-mail: vijayshankarpatho@gmail.com
Citation: Vijay Shankar S, Usha R. Epidermoid cyst of spleen. Online J Health Allied Scs. 2010;9(1):13
URL: http://www.ojhas.org/issue33/2010-1-13.htm
Open Access Archives: http://cogprints.org/view/subjects/OJHAS.html and http://openmed.nic.in/view/subjects/ojhas.html
Submitted: Jan 31, 2010; Accepted: Apr 2, 2010; Published: Jul 30, 2010
Abstract:
Splenic cysts are very rare lesions, most of them being parasit-
ic systs. Nonparasitic cysts are uncommon. We report a case 
of young female who presented with mass and pain abdomen. 
Ultrasound examination revealed splenic syst.  The diagnosis 
of epidermoid cyst was made based on characteristic lining on 
histopathological examination
Key Words: Epidermoid cyst, Spleen
Introduction:
Splenic cysts are rare lesions. Most of them are parasitic cysts. 
Nonparasitic cysts are uncommon lesions of spleen. Epiderm-
oid cyst is a nonparasitic cyst, present most frequently in 2nd 
and 3rd decades of life. The final diagnosis depends on histo-
pathological examination of the cyst.
Case Report:
A  28-year-old  female  was  admitted  with  the  complaint  of 
mass in the abdomen and left upper quadrant pain. On physic-
al examination the spleen was enlarged up to the umbilicus. 
USG abdomen showed a huge cyst measuring 16x11 cm in the 
left hypochondrium. Clinically a possibility of pseudopancre-
atic cyst and splenic cyst was made. Ultrasound examination 
revealed a cyst in the spleen. Patient underwent splenectomy 
and the specimen was sent for histopathological examination.
Grossly the spleen weighed 550 gm and measured 20x14x8 
cm. A cyst measuring 15x11cms replaced the major portion of 
the spleen. The inner cyst wall was grayish white and glisten-
ing and showed coarse fibrous trabeculations (Figure 1). His-
tologically the cyst was composed of thick fibrous wall and an 
interior lining of stratified squamous epithelium, without skin 
appendages (Figure 2). At places the epithelium was desquam-
ated. The diagnosis of epidermoid cyst of spleen was made.
Figure 1: Cut section of the spleen showing cyst with typical 
coarse trabeculation in the inner wall
Figure  2:  Microscopy  of  the  cyst  wall  shows  the  stratified 
squamous lining epithelium
1
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Online Journal of Health and Allied Sciences
Peer Reviewed, Open Access, Free Online Journal
Published Quarterly :  Mangalore, South India : ISSN 0972-5997
Volume 9, Issue 1; Jan-Mar 2010
Discussion:
Cystic lesions of the spleen include parasitic and nonparasitic 
cysts.1  Parasitic  cysts  are  almost  exclusively  caused  by  ec-
chinococcal disease and represent 50 to 80% of splenic cysts. 
Nonparasitic  cysts  are  classified  as  primary  or  true  cysts, 
which have an epithelial or an endothelial lining and accounts 
for around 10% and pseudocysts, which can be post traumatic, 
degenerative or inflammatory.
The epidermoid cysts lined by squamous epithelium are true 
cysts and are most likely congenital in origin and very rarely 
they can be familial.[2] They can develop from inclusions of 
splenic  surface  mesothelium  lining  into  the  splenic  paren-
chyma to form a cyst during development which later develop 
squamous metaplasia3 and gradually grow in size.
The diagnosis of true splenic cysts is commonly made in the 
second and third decades of life. The most common presenting 
complaint is pain which can be dull aching or fullness in the 
left upper abdominal quadrant.4 symptoms are more with cysts 
more than 8 cm in diameter. Occasionally these cysts can be 
an  incidental  finding  and  are  asymptomatic.  Rarely  can 
present with acute symptoms related to rupture, hemorrhage or 
infection.
The diagnosis can be made by CT imaging, but the final dia-
gnosis  depends  on  the  histopathological  examination  of  the 
cyst.
The epidermoid cyst has uniquely identifiable gross features. 
The inner wall of the cyst is gray white or smooth and glisten-
ing  and  have  prominent  trabeculations.5 This  appearance  is 
same regardless of histological lining. The fluid in the cyst can 
be of variable consistency ranging from thin to viscid. The flu-
id can be colorless to varying shades of green , brown or yel-
low.
Histologically the epidermoid cyst is usually composed of a 
loosely fibrous wall  and a layer of  stratified squamous epi-
thelial lining or a single layer of flattened epithelium without 
skin appendages. Sometimes the epithelium can be desquam-
ated and no lining exists in some portions of wall. If the lining 
is flattened it can be mistaken for the endothelium. Positive for 
keratin  and negative  for  factor  8  helps  in  diagnosis  of  epi-
dermoid cyst.
The treatment is surgical and splenectomy is the best choice. 
However spleen conservative  surgeries like  total  cystectomy 
or partial splenectomy  can be done for smaller cysts.5
References:
1. Brunicardi FC. Schwartz’s principles of surgery 8th 
edn. Newyork; Mc Graw hill 2005; 1307 
2. Kubo  M,  Yamane  M,  Miyatani  K,  Udaka  T, 
Mizuta M, Shirakawa K. Familial epidermoid cysts 
of  the  spleen:  report  of  two  cases.  Surg  Today. 
2006;36(9):853-6. 
3. Higaki K, Jimi A, Watanabe J, Kusaba A, Kojiro 
M. Epidermoid cyst of the spleen with CA19-9 or 
carcinoembryonic  antigen  productions:  report  of 
three cases. Am J Surg Pathol. 1998 Jun;22(6):704-
8. 
4. Robbins  FG,  Yellin  AE,  Lingua  RW,  Craig  JR, 
Turrill  FL,  Mikkelsen  WP.  Splenic  epidermoid 
cysts. Ann Surg. 1978 Mar;187(3):231-5. 
5. Morgenstern L. Nonparasitic splenic cysts:  patho-
genesis,  classification,  and  treatment.  J  Am Coll  
Surg. 2002 Mar;194(3):306-14.
2


Epidermoid cyst of the spleen with CA19-9 or carcinoembryonic antigen productions: report of three cases. Am J Surg Pathol.

Familial epidermoid cysts of the spleen: report of two cases. Surg Today.

Nonparasitic splenic cysts: pathogenesis, classification, and treatment. J Am Coll Surg.

Schwartz’s principles of surgery 8th edn. Newyork; Mc Graw hill

Splenic epidermoid cysts. Ann Surg.

Vijay Shankar S

Usha Ramachandra

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Epidermoid Cyst of Spleen

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